Hydroxychloroquine Retinopathy - Premaculopathy, part C

This 46 year old woman with systemic lupus erythematosus had taken HC for 7 years at 400 mg/d and stopped because of inadequate response. Three years later she was interested in restarting the drug and was seen for clearance. She was 5 feet 5 inches and had variable weight above 135 pounds and as high as 180 pounds over the years. The 10-2 visual field and the SD-OCT were both normal but the mf ERG was abnormal. When repeated 6 months later there was evidence of further deterioration of the mf ERG. The fundus was normal. Her visual acuity was 20/20 in both eyes but she subjective complaints of blurring.This image shows the first abnormal mf-ERG. The red circled amplitudes are lower than normal and the green circled waveforms are flattened. See parts A, B, and D too.